Surviving a brain tumor in childhood: impact on family functioning in adolescence

Parents and Their Children in the Face of Cancer: Parents' Expectations, Changes in Family Functioning in the Opinion of Caregivers of Children with Neoplastic Diseases-Further Studies

(1) Background: The onset and duration of the child’s illness is a difficult test for the entire family. The stress, in which the family lives from this moment, influences the relationships within it, as well as external relations with the environment. The child’s cancer fundamentally changes the way the family functions, the quality of interactions within the family, and life plans. (2) Patients and Approach: A population survey was run between 2015 and 2020. A cross-sectional study was conducted involving 800 family caregivers of children with cancer during active treatment. The aim of the study was to assess changes in the family functioning in the opinion of parents of a child with cancer. (3) Results: Parents experience chronic anxiety (67%), nervousness (60%), and worry (64%). For 50% of parents, the illness of their child entirely changed their plans. As many as 75% of parents feel guilty for exposing their child to carcinogens. According to the parents, the child’s illness is a psychological (89%), somatic (49%) and financial (77%) burden for them. Only 7% of children cause behavioural problems and 16% have trouble learning due to their sibling’s illness. (4) Conclusions: Cancer is a great difficulty for all members of a family system. The disease disturbs the balance within the family and relations in the family, as well as more distant psychological, social, and material consequences.

Family functioning and adaptation following pediatric brain tumor: A systematic review

INTRODUCTION

Pediatric brain tumor survivors (PBTS) experience psychosocial difficulties and poor quality of life (QOL). Family functioning may be adversely impacted by the stress of diagnosis and associated symptoms, which may, in turn, affect PBTS outcomes. The objective of this study was to complete a systematic review of family functioning and psychosocial outcomes in PBTS.

METHODS

We conducted systematic searches of PubMed and PsychInfo. Full-text articles (n = 324) were screened and 14 were included. A risk-of-bias assessment was conducted to evaluate the quality of study conclusions.

RESULTS

Studies examined associations of family functioning with adaptive, social, emotional, and behavioral outcomes, and QOL. More adaptive family functioning (cohesiveness, effective communication, lower conflict) was associated with better PBTS outcomes. Studies were limited by heterogeneous/small samples and cross-sectional designs.

CONCLUSIONS

Results provide preliminary support for the relationship between family functioning and psychosocial outcomes. Common outcome measures and prospective research designs can further advance understanding.

How Are Families Faring? Perceived Family Functioning Among Adolescent and Young Adult Cancer Survivors in Comparison to Their Peers

Purpose: Adolescent and young adult (AYA) cancer survivors' families can face ongoing challenges into survivorship. Families' adjustment and functioning as a unit can subsequently impact AYAs' mental health and quality of life. This study examined AYA cancer survivors' perceived family functioning, compared with their peers, and investigated factors associated with family functioning. Methods: Eligible participants were aged between 15 and 40 years, fluent in English, and cancer survivors who had completed treatment. AYA cancer survivors were recruited from hospital clinics, and the comparison group from an affiliated university campus. Participants completed the McMaster Family Assessment Device, Kidcope, and the Depression, Anxiety and Stress Scale-Short Form. We analyzed between-group differences in family functioning using multivariate analysis of covariance and used partial correlations to investigate associations between demographic cancer-related psychological coping variables and family functioning. Results: Ninety-three AYA cancer survivors and 141 comparison peers participated (ages: 15-32 years). AYA cancer survivors reported significantly better family functioning (p = 0.029), lower depression (p = 0.016), and anxiety symptoms (p = 0.008) compared with the comparison group. Approximately one-third of AYA survivors (34.4%) reported clinically significant maladaptive family functioning; however, this was more prevalent in the comparison group (50.4%). After adjusting for covariates, poorer family functioning was associated with AYA survivors using more avoidant escape-oriented coping strategies (p = 0.010). Conclusions: Our cancer survivor cohort reported better family functioning and psychological outcomes compared with their peers. Interventions targeting avoidant coping behaviors may support improved family functioning in some survivors. Further research disentangling the relationship between coping mechanisms and family functioning among AYA cancer survivors is needed.

Social attainment in survivors of pediatric central nervous system tumors: a systematic review and meta-analysis from the Children's Oncology Group

PURPOSE

Improved therapies for pediatric central nervous system (CNS) tumors have increased survival rates; however, many survivors experience significant long-term functional limitations. Survivors of pediatric CNS tumors can experience deficits in social attainment. The aim of this review was to systematically amalgamate findings pertaining to social attainment (i.e., educational attainment, marriage, employment outcomes) in survivors of pediatric CNS tumors.

METHODS

PubMed (web-based), PsycINFO (EBSCO), EMBASE (Ovid), and Web of Science (Thomson Reuters) were used to identify articles published between January 2011 and September 2018. Eligible studies reported outcomes for survivors of pediatric CNS tumors diagnosed before age 21 years and > 5 years from diagnosis and/or > 2 years off therapy. All data were independently abstracted by two reviewers. Random-effects meta-analyses were performed using Review Manager 5.0.

RESULTS

The search yielded 7021 unique publications. Forty-six were included in the current review. Meta-analyses revealed survivors of CNS tumors were significantly more likely to have completed compulsory education only (OR = 1.87, 95% CI = 1.66, 2.12, p < 0.00001), less likely to be married (OR = 4.70, 95% CI = 3.89, 5.68, p < 0.00001), and more likely to be unemployed (OR = 2.84, 95% CI = 2.62, 3.08, p < 0.00001) compared to non-cancer controls. Cranial radiation therapy, neurocognitive deficits, and younger age at diagnosis were associated with poorer outcomes. Hearing loss and bilateral blindness were also related to poorer outcomes. Sex did not impact social attainment outcomes.

CONCLUSIONS

Survivors of pediatric CNS tumors are at elevated risk for poor attainment of key adult social outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

There is a critical need to develop interventions to support survivors in becoming independent and productive adults.

The Many Roles of the Rock: A Qualitative Inquiry into the Roles and Responsibilities of Fathers of Children with Brain Tumors

A pediatric brain tumor diagnosis impacts an entire family unit, from diagnosis through curative treatment, and into survivorship or bereavement. Paternal caregiver experience has been significantly underexplored in pediatric neuro-oncology research as compared to maternal experience. This case series study explores the paternal roles, responsibilities, strengths, challenges, personal growth, and support needs of fathers of children with brain tumors receiving new palliative care consultations. In the study setting, a neuro-oncology diagnosis results in an automatic referral to the palliative care team, and thus, a convenience sampling model was employed based on consecutive palliative care consults for new childhood brain tumor diagnoses. In this study, four fathers of pediatric brain tumor patients receiving palliative care consultations responded to eight open-ended questions. Individual, voice-recorded interviews were transcribed for semantic content qualitative analysis. Analysis followed Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Participants completed quantitative surveys of their information preferences and support needs. Participants defined their father role as: being a team parent, an adaptable father, supporter, provider, a present father, and protector. Role conflict due to paternal responsibilities were recognized, such as the absence from the hospital to provide financial security for the family, and yet a desire to be physically present for the child. Fathers prioritized their knowledge needs about their child’s diagnosis, prognosis, and treatment above emotional needs. Fathers shared experiences of their personal growth through their child’s brain tumor diagnosis and advised on preferred support formats to include both verbal and written information. Understanding how paternal caregivers of children with cancer define their roles and goals has potential to improve the care and communication delivered to families of pediatric neuro-oncology patients.

Grandparents of children with cancer: a controlled comparison of perceived family functioning

PURPOSE

Grandparents can be profoundly emotionally affected when a grandchild is diagnosed with cancer. They also often provide invaluable support for the family (e.g., caring for the sick child and/or siblings). Multigenerational family functioning may therefore change. Limited research has assessed grandparents' perspectives after their grandchild is diagnosed with cancer. In this study, we aimed to (1) assess differences in perceived family functioning among grandparents of a child with cancer and grandparents of healthy children and (2) assess the cancer-specific and demographic factors related to perceived family functioning in grandparents of a grandchild with cancer.

PROCEDURE

Grandparents of a child with cancer (n = 89) and grandparents of healthy children (n = 133) completed the general functioning, communication, and problem-solving scales of the Family Assessment Device. We used multilevel models with a random intercept to detect (1) between-group differences and (2) identify factors related to perceived family functioning among grandparents with a grandchild with cancer.

RESULTS

Grandparents with a grandchild with cancer reported poorer family functioning than grandparents with healthy grandchildren. Among the grandparents with a grandchild with cancer, impairments in family functioning were correlated with fewer years since diagnosis, providing care to their sick grandchild and/or siblings and living far away from the sick grandchild.

CONCLUSIONS

The detrimental impact of childhood cancer likely extends beyond the immediate family members. Including grandparents in interventions-beginning at diagnosis-to reduce distress and increase cohesion for families of a child with cancer is warranted, particularly for grandparents who provide care to their sick grandchild or siblings.

Parents' Perspectives of Changes Within the Family Functioning After a Pediatric Cancer Diagnosis: A Multi Family Member Interview Analysis

Pediatric cancer is a life-threatening disease that challenges the life of the diagnosed child, the parents, and possible siblings. Moreover, it also places considerable demands on family life. The aim of this study was to explore changes in the family functioning after a pediatric cancer diagnosis. Ten couples who had a child with leukemia or non-Hodgkin lymphoma were interviewed individually about their experiences. Interviews were semistructured, and the data were analyzed using Multi Family Member Interview Analysis. Three themes emerged from the data: (a) Family Cohesion: Strengthened Versus Fragmented; (b) Educational Norms and Values: Overindulgence Versus Being Stricter, and (c) Normality: Loss Versus Preservation. The conflicting dynamics present in these emerging themes exemplify the complexity of this process of family adaptation. This study illustrates the need to take into account the family level, as well as the conflicting feelings parents may experience after a pediatric cancer diagnosis.

Youth and parent perceptions of parenting in childhood cancer survivors and healthy peers

PURPOSE

Having a child diagnosed with cancer may have a long-term impact on parenting practices. The aims of this study were to (a) examine possible differences in youth and parent perceptions of parenting between childhood cancer survivors and healthy comparisons, (b) determine the concordance between youth and parent perceptions of parenting, and (c) explore differences in parent-youth concordance between survivors and healthy comparisons.

METHODS

Participants were youth aged 8-18 years (N = 170 childhood cancer survivors, N = 114 healthy comparisons) and one of their parents. All patients were ≥ 3 years from diagnosis (M = 6.52, SD = 3.60). Both youth (Parental Bonding Instrument (PBI)) and parents (Parenting Relationship Questionnaire (PRQ)) reported on their perceptions of parenting. Two separate MANCOVA's (PBI and PRQ) were conducted to determine possible differences between childhood cancer survivors and healthy peers. Concordance between youth and parent perceptions of parenting was examined.

RESULTS

Survivors did not differ from healthy peers in their perception of parental care and overprotection (p = .890). Likewise, parents in the survivor and healthy peer groups did not differ in their perceptions of involvement, attachment, communication, confidence, or relational frustration (p = .360). Youth's report of a caring parent-child relationship was positively associated with parent-reported involvement, attachment, communication, and parenting confidence and negatively associated with parent-reported relational frustration. Youth-perceived overprotection was positively associated with parent-reported relational frustration. No differences were found in parent-youth concordance between survivors and healthy comparisons.

CONCLUSION

A history of childhood cancer does not appear to adversely influence parenting behavior, as perceived by both youth and their parents.

Quality of Life Among Parents of Adolescent and Young Adult Brain Tumor Survivors

We aimed to describe the quality of life (QOL) among parents of adolescent and young adult brain tumor survivors as well as parent, survivor, and diagnosis/treatment-related factors associated with adverse QOL. A cross-sectional study of 28 parents of adolescent and young adult brain tumor survivors (who were on average 10 y postdiagnosis) was used to assess QOL. Parent QOL was measured using the Patient-Reported Outcomes Measurement Information System Global Health measure. Factors associated with adverse parent QOL were explored using logistic regression including: parent, survivor, and diagnosis/treatment-related factors. Parent QOL was within the normal range; however, 40% scored below the clinical threshold of 0.5 SD below the mean for physical and mental health. Parent perceptions of greater family impact, survivor emotional/behavioral health problems, improved cognitive function, and recurrence were associated with adverse parent physical health. Parent anger/sorrow, uncertainty, survivor emotional/behavioral health problems, speech/language problems, and recurrence were associated with adverse parent mental health. Parental emotional resources and perceptions of improved survivor peer relationships were associated with greater parent physical and mental health. The impact of a brain tumor diagnosis and treatment on the QOL of parents may be significant. Interventions are needed to ensure that the needs of parents are met.

Measuring the burden of treatment for chronic disease: implications of a scoping review of the literature

BACKGROUND

Although there has been growing research on the burden of treatment, the current state of evidence on measuring this concept is unknown. This scoping review aimed to provide an overview of the current state of knowledge as well as clear recommendations for future research, within the context of chronic disease.

METHODS

Four health-based databases, Scopus, CINAHL, Medline, and PsychInfo, were comprehensively searched for peer-reviewed articles published between the periods of 2000-2016. Titles and abstracts were independently read by two authors. All discrepancies between the authors were resolved by a third author. Data was extracted using a standardized proforma and a comparison analysis was used in order to explore the key treatment burden measures and categorize them into three groups.

RESULTS

Database searching identified 1458 potential papers. After removal of duplications, and irrelevant articles by title, 1102 abstracts remained. An additional 22 papers were added via snowball searching. In the end, 101 full papers were included in the review. A large number of the studies involved quantitative measures and conceptualizations of treatment burden (n = 64; 63.4%), and were conducted in North America (n = 49; 48.5%). There was significant variation in how the treatment burden experienced by those with chronic disease was operationalized and measured.

CONCLUSION

Despite significant work, there is still much ground to cover to comprehensively measure treatment burden for chronic disease. Greater qualitative focus, more research with cultural and minority populations, a larger emphasis on longitudinal studies and the consideration of the potential effects of "identity" on treatment burden, should be considered.